Background"Examinations drive students' learning." This statement refers to what is assumed to be one of the strongest relationships in education. We explored in this research how and why students differ in their approaches to learning, how assessment affects deep learning, and which barriers stand in the way of good assessment and learning in the clinical years of a Problem Based Learning (PBL) graduate entry medical curriculum.FindingsMethod: We conducted a qualitative, phenomenological study using semi-structured group interviews with students and semi-structured individual interviews with teachers and students. The transcripts were analyzed, and themes were identified.Setting: The research was conducted at the King Saud bin Abdulaziz University for Health Sciences, College of Medicine, Riyadh, Saudi Arabia from November 2007 to March 2008.Results: A total of 28 students participated in 7 focus group interviews. Semi-structured individual interviews were conducted with 12 teachers and 12 students. The analysis yielded four themes: summative assessment, formative assessment, continuous assessment of clinical attachments, and learning objectives.ConclusionsThe results of this study confirm that assessment affects students' perceptions of learning and how they learn. These effects are not uniformly positive. According to the students, the predominantly summative assessment program offers little inducement to engage in deep learning. They express a clear preference for formative assessment, which may foster a deeper approach to learning. Efforts to achieve more clinically relevant assessment with adequate balance between the various types of assessment are required. Research is needed to decide this balance.

Objectives: The aim of the study was to investigate students? perceptions of assessment and the resulting learning styles.MethodsQualitative semi-structured interviews were conducted with 14 students and 8 clinical supervisors from Sydney Medical School and 12 students and 13 clinical supervisors from King Saud bin Abdulaziz University. Both institutions have similar curricula but a different assessment approach. The interviews were transcribed and analyzed using thematic analysis. Interview transcripts were stored and analyzed using ATLAS.ti.ResultsThree themes emerged from analyses of the interviews: the function of assessment, learning outcomes and, finally, authentic assessment in the clinical environment. A model is presented to show the relationship between contextual and different personal factors and students’ perceptions of the impact of assessment on learning styles.ConclusionsCultural differences and emotions can affect students’ perceptions of assessment and learning styles. A combination of formative and summative assessment based on learning objectives is required. This combination should take into consideration students’ cultural background, values and the implemented education system. This balance should be sufficient to motivate students in order to maintain their focus and attention, and reduce the potential negative impacts of a hidden curriculum. The experience of authentic assessment was a powerful motivator for students’ approaches to learning.

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